This page will be updated with summaries of presentations by 16 international top lecturers that will be given from Thursday 30 to Friday 31 May 2024 at the ORTHO-AMSTERDAM 2024 congress in Amsterdam.
Reflecting on orthodontics today: considering the BEGG perspective
A question that I find myself pondering almost daily is: What has truly changed since the introduction of the BEGG technique to Europe? What transformations have taken place in orthodontics over the past five decades?
Certainly, the human being remains the same, with the same number of teeth, identical bone structure, consistent oral health issues, and unaltered biological and aesthetic limitations. So, what sets today apart? It’s primarily the appliances – yet what impact does technology, the far-reaching influence of the internet, and our changed patterns of social interaction exert? Have the internet and social media only brought positive aspects, or do they mask certain missed opportunities?
I would like to extend an invitation to you, to join me on a deeply personal journey of reflection, exploring my individual perspective on orthodontics in the context of the European BEGG movement.
The limits of the dentition in Cl II correction
What are the limits in relation to the bone? Should we stay within the baseline framework… or can we push the limits moving teeth beyond the bony housing and maintain a healthy periodontium? The extraction/non-extraction debate is ongoing, but pre-treatment diagnosis involving the gingival phenotype and alveolar envelope in treatment planning may offer appropriate solutions. This way the patients can be approached individually, according to their needs and requests with a professional focus aiming for a harmonious position of the incisors in the face and in the alveolar bone. When extractions are needed, space closure can be accomplished on continuous wires or with sectional and segmented technique. The approach depends on the malocclusion, gingival and alveolar conditions. In extraction therapy, biomechanics, and anchorage control play key-roles in achieving the desired treatment objectives. The presentation aims to demonstrate limits and solutions with clinical examples.
Bone anchored maxillary protraction in patients with cleft
Bone Anchored Maxillary Protraction (BAMP) has proven to be an effective alternative for treating moderate Class III malocclusion in growing individuals. This lecture will present the outcomes of a fifteen-year experience at a single center regarding the use of BAMP in patients with cleft lip and palate, with a follow-up period of up to five years. The lecture will address several topics: What is the impact of BAMP on the zygoma-maxillary complex? How does BAMP treatment affect the soft tissue profile? Does BAMP treatment hinder the growth of the upper airway? Can BAMP treatment induce remodeling of the mandibular fossa? Can
predictive factors for favorable results be identified? What are the typical problems and complications associated with BAMP treatment? This lecture aims to provide a comprehensive understanding of the indications and contraindications for BAMP treatment in patients with cleft lip and palate.
Key words: cleft lip and palate, midface modification, bone anchored maxillary protraction, Class III maloclussion, upper airway.
Lorenz Moser and Ute Schneider-Moser
Orthodontic treatment solutions in patients with missing teeth in the esthetic zone
Patients affected by missing teeth in the esthetic zone due to agenesis or transpositions, impacted or retained teeth, tooth malformations such as dilaceration or enamel dysplasia, and the entire range of dental trauma may sometimes require unusual treatment approaches. The therapeutic challenge in these patients is to select 1) the most appropriate orthodontic strategy without the need for extremely sophisticated mechanics, 2) to keep treatment time within acceptable limits for not risking iatrogenic damages, e.g. major root resorptions and 3) to avoid the necessity for a future extensive implanto-prosthodontic rehabilitation whenever feasible. Simple, but efficient treatment strategies for clinical patients with missing teeth in the upper AND in the lower esthetic zone will be presented to explain the pros and cons of space closure and space opening.
Julia von Bremen
Herbst – New considerations on old principles
The Herbst appliance in all its variations is a commonly used appliance to correct a Class II malocclusion nowadays. Despite increasing popularity, however, several contraindications have crystallized over the last decades.
This lecture will focus on the side effects of Herbst treatment and the efforts made to handle these and highlight the possibilities the appliance offers in a patient-centered approach. Looking back at a time period of over 30 years since Hans Pancherz started his Herbst research at the University of Giessen the lecture will give an insight to what remained, what changed and what evolved from the original treatment protocol.
Title of presentation follows
Manfred Leunisse, Edwin Eggink, Dick Barendregt, and Jacqueline Surtea
Autotransplantation, a viable option for patients of all ages
Autotransplantation is a widely used treatment option in the Scandinavian countries. The principle supporting the success of autotransplantation, is a vital periodontal ligament, as published over the last more than 50 years. This periodontal ligament provides a normal development of the surrounding tissues and adaptation to the natural growth of the patient. This in sharp contrast to dental implants, which fail to have these characteristics and are therefore not applicable for adolescents and young adults ór adult patient with a high remodeling rate.
In the past 20 years, due to the interdisciplinairy approach within the referral practice Proclin Rotterdam, comparable healing is achieved with autotransplantion of teeth with closed apices. When the proper guidelines are applied, closed apices turn out to be as successful as the open apices, on the short as well as on the long term. Factors like an optimal endodontic treatment (preferably before transplanting), early functional loading and infection control are the main parameters for success. Based on the clinical success, autotransplantation has become an indication for tooth replacement at all ages and, when applicable, preferrable over treatment with dental implants.
How can we make our aligner treatments work better?
Orthodontic treatment with aligners can produce a high-quality treatment outcome. As in all orthodontic methods however, there is a steep learning curve. The most crucial factor is for the clinician, is to take full control when planning and working in the 3-D software. We will focus on aligner biomechanics and how separate and stage difficult movements to increase the treatment predictability and efficiency
The presentation is going to give an overview of treatment possibilities in different kind of malocclusions with aligners. Treatment of space deficiencies, open and deep bites will be shown and discussed. Further on, we are going to discuss and evaluate treatment quality, efficiency, and precision.
Guy de Pauw
The KISS principle 2024
The popular statement “Keep it simple, stupid” (KISS) means “avoid unnecessary complexity” to achieve high-quality treatment results without relying on many of the newer developments in the orthodontic field. In this day of high technology, it is refreshing to remind ourselves of what can be accomplished with a basic approach in diagnosis and a minimal of basic material, keeping in mind the basic underlying principles. Simple does not necessarily equal easy or short treatments. Keeping things simple can be tuff work. A good deal of time and effort must be devoted to allowing treatment to flow smoothly and successfully to the desired goal.
By presenting well treated cases fulfilling these principles, I’ll try to explain that there is no need to skip what was trained prior to all the modern technological developments that we see throughout the literature and in clinical presentations. Of course, we don’t have to see away of the technological developments of the last 20 years are useless – they have made treatment a little easier and more efficient for all of us – but an overreliance on advanced radiographic and digital techniques can result in a diminution of the skills and acumen of the individual clinician, who, in the final analysis, is responsible for the outcome of each treated case.
Basic principles and scientific and technological developments need to come together in orthodontics to continually rededicate ourselves to improve our basic skills. Only technology can never be a substitute for high personal standards and mastery of proven techniques.
Complications in orthognathic surgery: case selection
Unfortunately complications cannot be prevented in orthognathic surgery (OGS). Contemporary social media and even more scientific presentations may present an illusional image of limitless possibilities for improving, especially, facial esthetics with OGS which, in name, has been upgraded to Orthofacial Surgery (OFS). This all tends to lead to higher expectations, demands and attracts different patient categories to match at individual orthofacial consultations and it needs a deepened cooperation between orthodontists and maxillofacial surgeons.
Case selection is the first and probably most important step in preventing complications in OFS. In a classification for origin of complications, patient-factors, technical factors and system factors can be identified. Technical factors are far most represented in both orthodontics and surgical platforms: “what happened and how I fix it”. System related flaws have become very apparent in pandemic times with delay’s, organisational and financial draw-backs.
Patient factors in complications are unmistaken correlated with case-selection. First of all, the psycho-social contours need to be explored to match demands, indications and possibilities. Any mistake made builds in high risks to result in disappointment. Most appealing challenge is of course to identify body dysmorphic disorders, but also different psycho-social issues influence decision-making and sublimation of problems towards facial dysmorphia. An import factor in this category is grinding and clenching, this may produce complications in fixation and bone-healing and may lead to re-operations with higher morbidity. Precautions can and need to be made in these situations
General medical issues need to be addressed as usual in any surgical work-up and may be of tremendous influence on outcomes, including life-treathening situations. For orthofacial surgery some specifics need to be addressed, like obstructive sleep apnea, motoric disturbances of the facial and masticatory musculature.
Anatomic malformations which hamper routine orthognathic procedures need to identified on beforehand. In this respect CBCT scanning has made an extraordinary positive impact on identifying anatomic deviations which may prevent complications like bad splits, lack of fixation options, pre-existing sinusitis and nerve relationships.
Prevention is paramount, however complications are part of life and will occur. Sharing and discussing them among professionals, instead of ignoring and hiding is extremely important to steepen the learning curve of oneself and many others.
Treatment of open bite
Worldwide, 5% of the adult population suffer from an anterior open bite in the permanent dentition. An unaesthetic facial profile, speech problems, dysfunctions as well as an impaired bite and chewing function often result in a reduced quality of life making orthodontic treatment mandatory. Nowadays, the latter still represents a challenging task for the working orthodontist, especially in adults. However, aligner therapy as an innovative, comfortable and aesthetically more appealing treatment option should be considered as a very effective alternative to more established approaches like the classic and modified MEAW technique. Nevertheless, only a small number of clinical trials have been performed to date. This lack in research is currently addressed in our international, multicenter study which evaluates the skeletal and dental effects in adult anterior open bite patients that are treated exclusively with clear aligners (Invisalign®).
Class II management with skeletal anchorage
Class II malocclusion has the highest prevalence compared to those that characterize our patients. Nevertheless, very often the therapeutic approach to this type of malocclusion is based mainly on clinical opinions, dated and partial information. Frequently, therefore, the clinician, mainly if at the beginning of his orthodontic journey, is in difficulty in identifying the right choices that characterize the correct diagnostic and therapeutic path, poised between aesthetics and biological limits, between efficacy and efficiency. In certain cases, the choice of the anchorage and its orthodontic management can be extremely important for the outcome of the treatment. In these cases, the use of skeletal anchorage can deeply improve the efficiency and efficacy of the treatment, reducing clinical problems, patients’ compliance and, mostly important, giving to the clinicians a reliable and predictable anchorage. Several clinical protocols can be used for this purpose. Relative advantages and disadvantages will be analysed during the lecture.